A 59-year-old woman with a two-month history of neck pain, limb numbness, severe sweating, and dizziness was successfully managed using a Qi-benefiting herbal strategy combined with spinal adjustment.

Case ID: CHC-0073

Case Summary

This case describes a 59-year-old woman, a long-term desk worker, who presented with chronic neck pain that had progressed over two months to include limb numbness, dizziness, and abnormal sweating (especially after mild morning activity). The original report documented a conventional diagnosis of cervical spondylosis and hypertension, alongside a TCM assessment of Blood Impediment (Xue Bi) and Vertigo driven by Qi and Blood weakness with a disharmony of Ying (Nutritive) and Wei (Defensive) Qi. She was managed through a highly integrative approach utilizing “Zhao’s Balanced Spinal Adjustment” to mechanically relieve nerve compression, combined with a modified Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Substance Decoction) to rebuild her immune exterior, boost Qi, and unblock the meridians.

Patient Presentation

• Patient: 59-year-old female (Surname: Chen).
• Main Complaint: Neck pain accompanied by limb numbness, dizziness, and abnormal sweating for 2 months.
• History: The patient sought initial consultation on July 2, 2023. She had a history of long-term desk work resulting in chronic neck pain and occasional dizziness, along with a 2-year history of hypertension. Over the past two months, her condition deteriorated significantly. She developed limb numbness, severe neck pain, and worsened dizziness. Notably, she experienced frequent fatigue, an aversion to wind and cold, and profuse sweating (particularly after slight morning activity), accompanied by tinnitus and nasal congestion.
• Physical Exam: She appeared tired with a slightly pale complexion. The cervical physiological curve was straightened. The neck muscles were tense with localized tenderness beside the C5-C7 spinous processes. Her dizziness worsened when turning her head. The bilateral brachial plexus tension test was positive (+).

Examination and Diagnosis

• Imaging (X-ray): Showed a straightened cervical physiological curve, narrowed C5-C7 intervertebral spaces, and uncovertebral joint hyperplasia (bone spurs).
• Conventional Diagnosis: 1. Cervical spondylosis; 2. Hypertension.
• TCM Tongue and Pulse: The tongue body was pale with a thin, white coating. The pulse was sunken and fine (脉沉细).

TCM Assessment

The original practitioner interpreted the presentation as Blood Impediment and Vertigo driven by Qi Deficiency and Blood Weakness, with Disharmony of Ying and Wei (血痹、眩晕 – 气虚血弱，营卫失和).

According to the holistic principles of yin and yang Chinese Medicine prolonged desk work and aging depleted her foundational Qi and Blood. The profound lack of surface Qi left her exterior defensive boundary weak. This allowed external Wind-Cold pathogens to easily invade, disrupting the harmonious interaction between her Defensive (Wei) and Nutritive (Ying) Qi, which directly caused her abnormal sweating, aversion to wind, and frequent fatigue.

Simultaneously, the chronic structural stasis in her lower neck (C5-C7) physically trapped the blood flow. Because the blood was weak and stagnant, it could not nourish the extremities, resulting in “Blood Impediment” (manifesting as limb numbness). Furthermore, the lack of clear Yang ascending to the head, combined with a slight hyperactivity of Liver Yang, triggered the dizziness and tinnitus. Her pale tongue and sunken-fine pulse provided objective textbook confirmation of this systemic Qi and Blood depletion.

Treatment Approach

The primary treatment principle was to benefit Qi and warm the meridians, harmonize blood and unblock impediment, dispel phlegm and resolve dampness (益气温经，和血通痹，祛痰化湿). The strategy utilized a dual approach: mechanically correcting the cervical alignment to immediately relieve the trapped nerves, while internally utilizing a classic Han-dynasty formula to seal her leaking exterior and flood the limbs with warm, fresh blood.

Interventions and Herbal Formulas

• Zhao’s Balanced Spinal Adjustment (Manipulative Therapy):
  • The practitioner applied a comprehensive 6-step protocol: point pressing and kneading, stretching and traction, myofascial smoothing, neck pinching, traction-rotation (20°–30° to the affected side, then 25°–35° to the healthy side), and a specialized rotational lateral-pulling maneuver. This sequence safely released the severe cervical muscle spasms and mechanically decompressed the C5-C7 nerve roots.
• Internal Herbal Formula (July 2, 2023): A 12-herb decoction acting as a modified Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Substance Decoction).
  • Benefiting Qi and Warming Meridians: Huang Qi (Astragalus, 15g) is the sovereign herb, heavily boosting the superficial Wei Qi to secure the exterior. Gui Zhi (Cinnamon Twig, 10g) warms the meridians and scatters the wind-cold. Together, they harmonize the Ying and Wei to effectively stop the abnormal sweating and fatigue.
  • Nourishing Blood and Unblocking Impediment: Bai Shao (White Peony, 10g) and Zhi Gan Cao (Honey-fried Licorice, 6g) nourish blood and relieve severe muscle spasms. Dang Gui (10g), Ji Xue Teng (Spatholobus, 20g), and Xue Feng Teng (25g) powerfully nourish and move blood to eradicate the numbness in the limbs.
  • Tonifying Liver/Kidneys and Anchoring Yang: Du Zhong (Eucommia, 10g) and Mu Li (Oyster Shell, 10g) tonify the Liver and Kidneys, strengthen the bones, and anchor the rising Liver Yang to stop the dizziness and tinnitus.
  • Strengthening Spleen and Resolving Phlegm: Bai Zhu (10g), Fu Ling (25g), and Chen Pi (Tangerine Peel, 4g) invigorate the Spleen to transform the underlying phlegm-dampness contributing to the dizziness.
  • Administration: 3 doses, water decocted, taken warm morning and evening.

Follow-Up

• Second Visit (July 5, 2023): After just 3 doses and the initial manual therapy, the patient reported that her neck pain and dizziness were significantly relieved. The limb numbness, aversion to wind and cold, and excessive sweating also showed marked improvement.
• Outcome: The practitioner prescribed 3 additional doses of the exact same formula. During a later follow-up, the patient reported that the limb numbness, aversion to wind, and sweating were completely eradicated, with no remaining symptoms.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the seamless integration of classic Jin Gui Yao Lue (Essential Prescriptions from the Golden Cabinet) theory for a modern orthopedic condition.

Often, cervical spondylosis is treated purely as a localized, structural problem using heavy blood-invigorating or pain-stopping herbs. However, Professor Zhao recognized that this patient’s presentation included systemic neurological and autonomic dysfunction—specifically, the severe sweating, fatigue, and aversion to wind—matching the classical description of “Blood Impediment” (Xue Bi). By strictly prioritizing the repair of the body’s energetic boundary (Ying and Wei Qi) using Huangqi Guizhi Wuwu Tang, while simultaneously applying precise mechanical bone-setting to the C5-C7 segments, the treatment permanently resolved both the physical nerve compression and the profound systemic weakness.

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Source Original source: Zhanjiang Second Hospital of Traditional Chinese Medicine / Guangdong Provincial Administration of Traditional Chinese Medicine Original title: 【以案说医】招仕富：益气温经，和血通痹，祛痰化湿法治疗颈椎病案 Practitioner: Professor Zhao Shifu (招仕富) Publication date: August 20, 2024 Original language: Chinese ChineseHerb.org version: English translation and editorial adaptation